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This Is a True Dystopian Healthcare System. And It Still Beats America’s.

Alexander Nanau’s new documentary ‘Collective’ chronicles a fatal health-care coverup in Romania and the brave activists who took on the system as the government let its people die

Collective is the story of a tragedy, and then the tragedy that followed. On October 30, 2015, a fire broke out at Colectiv, a nightclub in Bucharest, killing 27 and injuring nearly 150 others. In the wake of such profound grief, the Romanian government (famous for its crookedness and incompetence) insisted that its medical institutions had the capabilities to handle so many victims, resisting public requests that the injured be flown to other countries to be treated. That’s when the second tragedy occurred. Soon after the fire, burn victims began dying in Romanian hospitals under mysterious circumstances. The government tried to dismiss the deaths as not being unusual, but eventually the truth came out: The powerful disinfectants meant to sanitize the facilities had been extremely diluted, the result of rampant bribes and widespread corruption. A nation rocked by anguish faced a new shock, resulting in calls for government reform and greater transparency within Romania’s health-care system.

All the while, Alexander Nanau’s cameras were rolling. Born in Romania but spending much of his life in Germany, Nanau (Toto and His Sisters) is an observational documentarian, embedding in the worlds that pique his curiosity. Collective grew out of Nanau’s interest in following a journalist, Catalin Tolontan, who alongside his colleagues at the daily paper Gazeta Sporturilor (The Sports Gazette) helped break the story that diluted disinfectants were contributing to the needless deaths of burn victims. Despite the fact that the Romanian government didn’t take Tolontan seriously since he was the editor-in-chief at “just” a sports paper, he and his team managed to uncover a scandal that many that worked in hospitals knew about but were afraid to share with the world. 

As a result, the first half of Collective is an electrifying newsroom drama akin to All the President’s Men or Spotlight. But, as befitting a documentary that includes plot twists, including a high-profile suicide, Collective radically shifts gears at its midpoint, turning its focus to Vlad Voiculescu, a bright, idealistic young man in his early 30s who, as part of the country’s attempt to revamp its bureaucratic health-care industry, is selected to become the new Minister of Health. Voiculescu, part of the country’s new technocrat government, believes he can change Romania; Nanau shows us in detail just how hard that will be.

Recently selected as Romania’s official entry for Best International Feature Film at next year’s Oscars, Collective is equal parts fascinating, moving and infuriating. Nanau prides himself on avoiding voiceover or on-camera interviews with his subjects. Instead, we just follow along as Tolontan and Voiculescu both try to make their homeland a better place. The documentary has a gripping procedural quality, first illustrating how a Romanian publication chases after leads and zeroes in on a scandal, and then presenting the soul-crushing meetings and tense press conferences in which Voiculescu watches his optimism smash against the rocks of a government that may have switched leadership but is no closer to embracing systemic change. (Spoiler alert: In Romania, the mob has many fingers in many pies.) Nanau’s unobtrusive lens makes us feel like we’re eavesdropping on intimate moments — we’re watching history as it unfolds.

When I spoke to Nanau via Zoom from Bucharest last week, it had actually been the second time we’d talked. (Previously, I’d moderated a discussion with him for the International Documentary Association.) But that conversation was more about the technical aspects of Collective. This time, I wanted to dig into the documentary’s themes — specifically, how the film depicts Romania’s broken health-care system. The more we talked, the more apparent the depth of his country’s bureaucratic quagmire was. (As he told me, Collective is such a black eye for the government that there was an initial attempt to block its selection for the Academy Awards.) But for Nanau, the urge to tell this story didn’t necessarily derive from patriotic fervor.

“I don’t identify with being Romanian or German,” he says. “I was an immigrant in some kind of way all my life. I don’t identify with ‘I have to [say] something about Romania,’ but I feel for sure I want to reflect something about our society that I care about. My films are always very much linked to myself and what I want to learn or want to dive deeper [into].” 

We spent some time diving into what he learned while making Collective, the steps he went through to make sure the Romanian Secret Service didn’t take his footage and why he still prefers Romania’s health-care system to ours in the States.

Collective paints Romania’s health-care system as nightmarish. I take it the response to the Colectiv tragedy was just the latest indication of the corruption going on.

The health-care system that came out of the communist system is a system in which — as in all the former communist countries — doctors would get bribes. You want to be treated? You have to bribe. Peasants would bribe with eggs or whatever — that’s how it works. 

My father is a doctor and was trained here — we moved to Germany and he was a doctor there, so I know the differences. Basically, it starts in the [medical] schools — [doctors] are trained that they are gods. Even for the tests that you have to pass, there is open corruption — they manipulate the tests, and they manipulate who will test you, what questions you will get. Then, bribes are paid if you want to get a good job in a hospital. 

It’s a corrupt system in which it’s very hard for the honest doctors to do their profession. Every citizen pays his insurance, and the political parties [would use] the health-care system to drain the money out of it and bring it to the parties for their political campaigns. It’s just a whole system of how to steal money. 

Had there been other major scandals before this one? 

You knew that hospital managers buy equipment, get a bribe and [then] just put the equipment in the basement of the hospital, because they don’t even care about using it. You knew that doctors, in order to perform complicated surgeries for people who have no money, would say, “Listen, you have cancer. Go back home, sell your house, come back with the money — you’ll get the surgery.” 

I mean, that level of inhumanity was known, but the level of organized crime that accompanies diluting disinfectants for 10 years, selling it to 350 hospitals… There’s a saying that there is no family in Romania that doesn’t have a member that’s fighting a hospital infection or died of a hospital infection. It’s a well-known problem, but the system denies that it exists. Diluting disinfectants in so many hospitals, it’s the scale of an experiment, but [they’re doing it] on a whole society.

In America, there’s an endless struggle to achieve universal health care — it’s stigmatized by critics as being “socialized medicine.” But what happened in Romania would seem like a warning of the worst-case scenario. 

It’s universal health care that should work like in all other European countries: You pay a percentage of your salary, which is very small, into the health-care system. Most of the hospitals are state-owned, and you can go to the hospital and get treatment, everything for free, because you pay every month. I prefer that system instead of a system, as in the States, where I break my arm and I have to pay $20,000 for somebody to fix my arm. This is ridiculous. For a European citizen, that’s like, “What’s the difference between this and somebody breaking into your house, putting a gun to your head and saying, ‘Give me all your money?’” 

Catalin Tolontan

Collective is, in part, about the importance of journalists. It took reporters at The Sports Gazette to break this story. But I’m curious about the state of Romanian journalism as a whole since no one else was able to uncover this corruption. 

The profession was destroyed by the fact that so many media outlets were owned by powerful people that were very close to the governing power — you don’t really have journalists that are specialized on certain things. That’s why [traditional media outlets] failed so badly after the fire. The authorities said, “We can take care of these burn patients,” but if we would have had specialized medical journalism, [those reporters] would have said, “No way, that’s a big lie. A burn patient cannot be treated in a normal hospital. You will kill him. He will get infected. He will die.” If a burn patient survives the first 24 hours and is in a proper burn unit, the death rate is really low. 

But we had no specialized press, so, for Tolontan [and his colleagues], they really had to learn the medical world. That meant for them, day and night, meeting people, understanding the profession and the medical part of the problem. They were afraid of making mistakes, of breaking stories that weren’t true [where] they could be attacked and discredited.

I imagine that it would be easy for these journalists to be dismissed by the government. 

When [The Sports Gazette] started to talk about infections, they were attacked by the whole medical class: “These are sports journalists. They have no clue about hospital infections — they don’t exist. The burn patient, if they were infected, they were infected in the club. Or they were infected on the asphalt where they were sitting before the ambulance took them,” which is a big lie. Hospital infections exist only in hospitals. 

So [the journalists] then managed to procure the medical data of [these patients], with evidence of the infections that the hospital tested. [The doctors] finally let them be flown out to burn units, going out to Brussels, to England, to the Netherlands, to Germany. But they erased [proof of] the infections from all the patients’ files. [The doctors in other countries] said, “They aren’t infected — we can’t see infections in their file. The antibiotics are much too tough. Let’s take them off and find the right cocktail.” 

And because these doctors didn’t know the full story, they took the burn victims off antibiotics and some died.

One has to imagine what perverted minds these [Romanian] doctors must have to erase the infections [from] the files. This is insane.

Did people go to jail for this? 

Not the doctors or managers — or the authorities that lied that the patients [were] getting surgery in a newly-opened burn unit that wasn’t opened. 

Why weren’t they prosecuted?

It seems that the judicial system was [corrupted], but journalists also have another explanation. Prosecutors have families, and they need to go to hospitals — and in a society with a culture of making a phone call [to] somebody to help you get better treatment, they prefer not to prosecute doctors and not to prosecute health officials. They never know when they will need them for their own health and their own family.

Vlad Voiculescu

Vlad is presented as a passionate idealist trying to change this system. You spent a lot of time with him. Did you think he could really make a difference? Or was the system so corrupt he had no chance?

I had mixed feelings, to be honest, because I understood that the public servants in the ministry are so wicked. The problem is the way the system works: To sign one paper, you need five offices in your ministry to sign them. So if four out of five just say, “Oh, I’m sick today, I didn’t have time to sign, I’ll sign it tomorrow,” and tomorrow he doesn’t sign it… Well, that’s how they work.

Also, as you see in the film, Vlad [will propose something], and they’ll say, “That’s not your job. Listen, we will recommend what to do, and you just say if you want to do it or not.” The public servants in the system are the gods because they’re owned by the [political] parties.  

Vlad let you film him because he thought the Romanian health-care industry had to be transparent. I don’t want to spoil it for people who haven’t seen Collective yet, but transparency didn’t end up helping him.  

Now it’s not transparent at all. I must say that we benefited from the general mood that was in the Romanian society when the technocrats [came to power in 2015]. Everybody thought, “Change is coming.” There was this mood of, “Okay, now let’s open up.” And we benefited from it, because I’m not even sure that the journalists would have let us in if there wasn’t this [new mood]. Basically, they’re all in the same boat: “We all want to know the truth.” And that was the mood of the first six months after the Colectiv fire: “Let’s take control in society back.”

You mentioned to me that when you first met with Tolontan about filming him, he thought you might be Secret Service. Was that a reasonable fear on his part?

[It’s been suggested] that many journalists in Romania are actually [Secret Service] agents. So there is a paranoia, for sure, coming out of the communist system — although I always feel bad saying “coming out of the community system,” because the communist system is just child’s play in comparison to what the NSA is doing. 

I was afraid when I made the film that [the government] would break into my office, into our studio, and steal our footage. That’s why we organized it in very different places and throughout the country. Every evening, we would secure the footage on multiple sources. It’s the same way [The Sports Gazette] were paranoid that [the government] was listening to the phones: When they had certain meetings in the newsroom, they put the phones far away, because it’s known that the Secret Service is listening to the phones. 

Have you been harassed by the government since making Collective?

No, but they had a general rule: “Nobody should talk about the movie.” There was a press screening before [the film] came out [in Romania], and everybody said, “That is the biggest press conference in recent Romania history.” We had 120 journalists in the room. The next day, not a single one wrote about it. Five of them, I think, posted on Facebook, but none of them wrote in their outlets about it. 

At a certain point, they couldn’t avoid it anymore because the film got all this attention outside of the country. But even now, when the film was announced [as Romania’s International Feature entry for the Oscars], it wasn’t the Romanian Film Center or the Ministry of Culture that nominated it. It was an independent commission of film critics that voted for the film to be Romania’s entry. The Ministry of Culture and the head of the Romanian Film Center were alarmed and were trying to see if there was a way to reverse the decision. And they were directly told, “You can try, but it will be in papers internationally. Do you want that?” 

It’s been five years since the Colectiv fire. Do Romanians still remember? 

The 30th of October, we just had the commemoration. [The fire] is a point of reference for a new beginning or a wind of change. Every year, we meet, and there’s a big march in the streets. This year, because of COVID, what was done was, from the Palace of Justice to the club, we made a chain. Everybody with a camera in his hand, separated by two-and-a-half meters, and we made a chain of people, just to remind the prosecutors that they forgot something.

Collective makes it clear how risky it was for whistleblowers to speak out about the dilution of disinfectants. Did the movie embolden more people to share what they knew?

After the film was released [in Romania], the number of daily whistleblowers with valid leads to corruption went up 10 times per day. Then the pandemic started, and there were a lot of leads [in terms of] acquisition of equipment, not respecting protocols in hospitals and explaining why the hospitals became the focus of COVID spreads. So that’s what’s changed: People speak up.

Do you feel like anything’s changed in the medical industry in Romania?

Today, doctors have a mantra: “Nobody in the Romanian health-care system ever has stolen so much money as Vlad Voiculescu.” It’s their way of telling themselves, “I’m not a crook.” 

They’re lying about Voiculescu to make themselves feel better.

Basically, they take over the propaganda from media outlets that [said that] Vlad, behind his well-intended talk, stole money. Nobody can prove it: “We don’t know exactly how he stole the money…” But that’s what they tell themselves.

Another funny thing is that, now, at one of the biggest hospitals in Bucharest, a group of doctors said, “Okay, we’re not going to take bribes anymore.” So they do group therapy. [The bribes] are like a drug — if they don’t get an envelope with the extra money in the morning… I mean, we have to be clear about the amounts doctors make as bribes. They have hundreds of thousands of euros stacked in their basements. A [crooked] doctor leaves the hospital every day with at least 1,000 to 2,000 euros in bribes. So now they’re doing therapy sessions together, because they feel they can’t work anymore. [The bribes] are a very physical, anatomic thing — their brains don’t fire anymore without that money. [Laughs] You could make a short film about it.

You’ve talked to a lot of journalists around the world about Collective since last year when it premiered at the Venice Film Festival. Because this is a movie about journalism, I’m wondering if there’s anything you’re surprised they don’t ask you.

I’m always surprised that nobody says, “Basically, it took a normal citizen that isn’t bound to politics to say the truth.” That’s what Vlad is saying in the film: “We don’t have the capacity to treat these patients.” It takes a normal citizen that doesn’t fear a political system to say the basic and simple truths about the capacity of a state, or what it’s able to do or not to do. 

There’s this press conference [in the documentary], and people attack him [for saying], “We cannot treat burn patients.” If somebody would have said that in the beginning, from that powerful position of the Minister of Health, everybody would have been flown out [to Germany], and the whole [tragedy] wouldn’t have taken place. There would have been a happy story to tell. 

In Europe, there’s this thing, it’s called the Mechanism of Civil Protection. Every European country and some non-European countries, if they have a catastrophe that goes over a certain number of victims — be it an earthquake or a fire like this one — the government pushes a button. And within the next 24 hours, depending on what is happening, NATO planes fly in and distribute the victims into other European hospitals. 

That’s so beautiful about the European Union, and that’s why we need it. And [Romania] could have just pushed this button — and they didn’t do it. 

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